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Family-centred Caesareans

By Cas McCullough © 2007

Women’s experiences of caesarean section vary as much as women’s experiences of vaginal birth but when all is said and done, what is important in birth is universal to all women regardless of how their babies births unfold.

I recently prepared a talk on advocating for family-centred caesareans for the Australian College of Midwives Queensland State Conference and as part of that I went online to a popular mainstream forum to seek out the views of women who have experienced caesareans. My aim was to form a picture of what practices were common and what women actually thought would make the experience of having a ceasarean a better one.

The responses I received painted a clear picture that maternity units could be “doing” caesareans better. The issues that were flagged as most important to the women who responded were the same as those that have been flagged time and time again by women who have had vaginal births. Women indicated they wanted to feel: respected, significant, acknowledged, supported (both emotionally and physically) and provided with continuity of carer wherever possible. Concerns were expressed over staffing, lack of continuity of carer, communication problems, being ignored and even being discriminated against.

Next are comments showing common experiences*:

“The OB paid so little attention as to tell me I had a "healthy-sized son." I had a daughter. It made me feel quite small, and made my birth seem very insignificant when he hadn't even noticed the baby he just delivered had a vagina. Mum had an “elective” cs at 42 weeks.

“I felt as though everything was taken out of my hands - it was like I was a pre-schooler and they were the Headmaster.” Mum had an emergency cs at term.

“In all honesty I felt like I had been knocked out and my baby was ripped out of me and stolen.” Mum had emergency cs at 28 weeks, baby flown to different hospital.

“The surgeon/s (still don't know how many) didn't introduce themselves to me, didn't speak to me, just worked on me and left.” Mum had an emergency cs at term.

“I remember waking up not knowing where my baby was, where my husband was - it was an awful moment. In recovery, I was completely alone…” Mum had an elective cs at term.

“I would give anything to repeat that day over again and not go through it. At the end of the day I had a healthy baby girl and that is about the only nice thing I can think of about it!” mum had an emergency cs, no labour.

“Nobody talked to me about my experience at all. I felt extremely alone in recovery. Nobody stayed with me although obviously there were nurses around. Some kind of emotional support, not just medical, would have been helpful.” mum who had an emergency cs.

“Having a trainee doctor (or whatever he was) getting questions wrong as he was learning to stitch me up wasn't the best thing to be listening to!!!” Mum had elective cs for breech baby.

What is a family-centred caesarean?

Part of CANA’s mission is to:

· advocate for evidence-based and compassionate practices and policies regarding caesareans and birth after caesarean.

· promote access to appropriate support for women undergoing caesarean section births.

In order to achieve the above objectives, CANA has undertaken a number of initiatives. We have offered a caesarean birth plan on our website and developed a poster series based on this birth plan. We also talk about the needs of families who are affected by caesarean surgery as much as we can: to politicians, hospital administrators and care providers… to get a message across that women having caesareans need and deserve to be well supported.

CANA defines a family-centred caesarean as one in which the family’s physical, social and emotional needs (mother, baby and partner) are seen as the highest priority in the lead up to, during and after a caesarean birth.

What makes a caesarean birth family-centred boils down to meeting the unique and specific needs of the individual mother and her partner and their baby. Some aspects that might make a caesarean family-centred may include:

· The birth being respected as a rite of passage for the family.

· The mother and her partner considered active decision-makers surrounding their baby’s birth.

· The mother being acknowledged and supported by all medical staff throughout the caesarean experience (whether emergency or planned caesarean).

· Babies removed slowly from the womb and placed directly on the mother’s chest (or within the mother’s reach).

· The cord not being severed until pulsating has ceased if possible to provide more oxygenated blood to the baby.

· Skin-to-skin contact between mother and baby being encouraged immediately upon birth (see Sarah Buckley’s article on skin-to-skin contact over the page)

· Early assistance with breastfeeding in recovery being routinely given.

· Babies not being unnecessarily separated from their mothers upon birth.

· Fathers being able to and encouraged to bond with their babies if the mother is unable to immediately upon birth (such as when the mother is under General Anaesthetic).

· Dedicated (and optimally one-on-one) midwifery support being provided for the mother in the lead up to and throughout the experience of caesarean birth and early postnatal period.

Comments by women who responded to my questionnaire confirmed that some of these aspects would be or were helpful:

“I think that if everyone …treated me like a human being instead of a vessel that just happened to have a baby stuck inside that needed removing, then it would have made my experience better.” mum who had an elective cs at term.

I would've loved the opportunity to cuddle her, touch her, see her properly in the theatre and in recovery (with all the other surgery patients). It would've made the 35mins I was being stitched up for a little more happy.” mum had elective cs for breech baby.

“…The midwife who was with me from the start of the operation was with me in recovery and patiently showed me how to b/f and skin to skin bond with my daughter. It was a fantastic feeling being wheeled into recovery with my new daughter actually on my chest snuggled looking into my eyes…” mum who had an elective cs at term.

How does your local maternity unit rate?

CANA often receives requests from women about making their caesarean experiences better but even when we do share some tips, some maternity units and medical staff are reluctant to meet mothers’ needs.

Many hospitals still send babies to special care nurseries while the mother is in recovery and very few routinely provide mothers with the opportunity for skin-to-skin contact upon birth.

If you would like to know more about how you can promote family-centred caesarean births at your local maternity unit contact CANA or the Maternity Coalition for further information: info@canaustralia.net or maternitycoalition.org.au.

*to protect mothers’ privacy, names have been withheld. However, permission was given for the use of comments in this article on family-centred caesareans.

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